Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis

Détails

ID Serval
serval:BIB_D9D9E325DE62
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis
Périodique
Circulation
Auteur(s)
Auer R., Gaume J., Rodondi N., Cornuz J., Ghali W.A.
ISSN
1524-4539
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
117
Numéro
24
Pages
3109-3117
Langue
anglais
Résumé
BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.
Mots-clé
Acute Coronary Syndrome, Cause of Death, Clinical Trials as Topic, Humans, Inpatients, Patient Selection, Recurrence
Pubmed
Web of science
Open Access
Oui
Création de la notice
22/01/2009 15:09
Dernière modification de la notice
09/05/2019 2:02
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